Pathogenicity of the open processus vaginalis peritonei

: In 100 postmortem examination on adults whose age at the time of death had been between 21 and 85 years, an only partially obliterated processus vaginalis or Nuck's diverticulum was seen in 29 cases. Whereas in women the peritoneal bulges often represented only pointers to a patent diverticulum, never being longer than 1 cm, in every fourth man there was a unilateral or bilateral processus longer than 2 cm and wider than 0.5 cm. However, none of the p.m. examined adults had been suffering from inguinal hernia during lifetime. The results point to the possible conclusion that persistence of a processus vaginalis without development of hernia is by no means unusual--in fact, it is even normal. Since the alleged pathogenicity of the patent processus supplies the basis for applying herniography and contralateral exploration, we must doubt whether this procedure is justified. In addition, it must be borne in mind that both x-ray diagnosis and surgery of processus vaginalis can be associated with risks, such as excessive radioexposure of the gonads and atrophy of the testes as a result of lesions of the spermatic cord system. Even if these risks are kept at a minimum, the following reasons can be advanced against the x-ray method and hence also routine bilateral herniotomy: 1. the processus vaginalis is already obliterated; herniography and surgery would be unnecessary; 2. a patent processus vaginalis can be obliterated on its own even after x-ray demonstration; 3. a patent processus is not a hernial sac and will not necessarily result in subsequent inguinal hernia.